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儿童莱姆病的临床特征和血清学特征：瑞士一项为期15年的回顾性队列研究

Clinical characteristics and serological profiles of Lyme disease in children: a 15-year retrospective cohort study in Switzerland.

作者信息

Greiter Beat M, Sidorov Semjon, Osuna Ester, Seiler Michelle, Relly Christa, Hackenberg Annette, Luchsinger Isabelle, Cannizzaro Elvira, Martin Roland, Marchesi Martina, von Felten Stefanie, Egli Adrian, Berger Christoph, Meyer Sauteur Patrick M

机构信息

Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.

Emergency Department, University Children's Hospital Zurich, Zurich, Switzerland.

出版信息

Lancet Reg Health Eur. 2024 Dec 9;48:101143. doi: 10.1016/j.lanepe.2024.101143. eCollection 2025 Jan.

DOI:10.1016/j.lanepe.2024.101143

PMID:39736882

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11683244/

Abstract

BACKGROUND

Lyme disease (LD) is caused by and is the most common tickborne disease in the northern hemisphere. Although classical characteristics of LD are well-known, the diagnosis and treatment are often delayed. Laboratory diagnosis by serological testing is recommended for most LD manifestations. The objective of this study was to describe clinical characteristics and associated serological profiles in children with LD.

METHODS

This retrospective cohort study included children aged 0-18 years, diagnosed with LD according to current guidelines at University Children's Hospital Zurich between January 1, 2006 and December 31, 2020. Two-tier serological testing with the Well enzyme-linked immunosorbent assay and Line Western blot (MIKROGEN Diagnostik, MIKROGEN GmbH, Neuried, Germany) was performed at the Institute of Medical Microbiology, University of Zurich.

FINDINGS

In total, 469 children diagnosed with LD were included (median age, 7.9 years); 190 patients (40.5%) with Lyme neuroborreliosis (LNB), 171 (36.5%) patients with skin manifestations (erythema migrans, = 121; multiple erythema migrans, = 11; borrelial lymphocytoma, = 37; and acrodermatitis chronica atrophicans, = 2), and 108 (23.0%) patients with Lyme arthritis. We observed seasonal variations for patients with skin manifestations and LNB, with high prevalence in May-October, but not for patients with Lyme arthritis. Significant differences between LD manifestation groups were found for age, inflammatory parameters, and specificity and concentration of -specific serum antibody responses. We observed distinct patterns of pronounced serum antibody responses against antigens in LNB (IgM against VlsE, p41, and OspC) and Lyme arthritis (IgG against p100, VlsE, p58, p41, p39, and p18).

INTERPRETATION

Our study is one of the largest and most detailed for children with LD. We present unique findings regarding the differences in clinical characteristics and immune responses between various manifestations of LD in children.

FUNDING

No specific funding to disclose for this study.

摘要

背景

莱姆病（LD）由[病原体未提及]引起，是北半球最常见的蜱传疾病。尽管莱姆病的典型特征广为人知，但诊断和治疗往往会延迟。对于大多数莱姆病表现，建议通过血清学检测进行实验室诊断。本研究的目的是描述莱姆病患儿的临床特征及相关血清学特征。

方法

这项回顾性队列研究纳入了0至18岁的儿童，这些儿童于2006年1月1日至2020年12月31日期间在苏黎世大学儿童医院根据现行指南被诊断为莱姆病。在苏黎世大学医学微生物研究所采用Well酶联免疫吸附测定和线性免疫印迹法（MIKROGEN Diagnostik，MIKROGEN GmbH，德国诺伊里德）进行两层血清学检测。

结果

总共纳入了469例被诊断为莱姆病的儿童（中位年龄7.9岁）；190例（40.5%）患有莱姆神经疏螺旋体病（LNB），171例（36.5%）有皮肤表现（游走性红斑，n = 121；多发性游走性红斑，n = 11；疏螺旋体淋巴细胞瘤，n = 37；以及慢性萎缩性肢端皮炎，n = 2），108例（23.0%）患有莱姆关节炎。我们观察到有皮肤表现和LNB的患者存在季节性变化，5月至10月患病率较高，但莱姆关节炎患者不存在这种情况。在年龄、炎症参数以及伯氏疏螺旋体特异性血清抗体反应的特异性和浓度方面，莱姆病表现组之间存在显著差异。我们观察到LNB（针对VlsE、p41和OspC的IgM）和莱姆关节炎（针对p100、VlsE、p58、p41、p39和p18的IgG）中针对伯氏疏螺旋体抗原的明显血清抗体反应模式不同。